ARETROSPECTIVE OBSERVATIONAL STUDY: EVALUATING THE APPROPRIATENESS OF ANTIBIOTIC DOSING IN CHRONIC KIDNEY DISEASE PATIENTS AT A TERTIARY CARE HOSPITAL

The renal system helps in the urinary excretion of drugs in unchanged form or metabolites. Since a majority of the drugs are eliminated by the kidneys, impairment in renal function can lead to drug accumulation, toxicity, and therapeutic failure. As a result, patients with impaired renal function require careful dose modifications. The purpose of this study was to determine the most frequently prescribed dose-unadjusted antibiotic and to assess the appropriateness and rationality of antibiotic dose adjustments in patients with Chronic Kidney Disease (CKD). Additionally, the study aimed to pinpoint the factors contributing to incorrect dosing adjustments. A retrospective observational study was conducted from December 2022 to November 2023 and medical records of the study subjects admitted to the nephrology department of Mallige Medical Centre, Bengaluru, were reviewed for antibiotic prescriptions. This study included 651 participants in total, with a p < 0.05 level for statistical significance. The findings showed that 35 different antibiotics were prescribed to patients with CKD, with 71.42% (25/35) requiring renal dose adjustments. Notably, 51% (332/651) of the reviewed prescriptions had unadjusted antibiotic doses, while the remaining prescriptions had proper adjustments. Statistical analysis using the Chi-Square test revealed significant correlations between improper antibiotic dose adjustments and the following factors: multiple antibiotic prescriptions per patient (p-0.000609), comorbidities (p-0.000942), length of hospitalization (p-0.023155) and CKD stage (p-0.032541). The study revealed that a substantial proportion of patients with renal impairment received unadjusted antibiotic dosing, thereby increasing their vulnerability to adverse drug reactions, therapeutic failure, and elevated risks of morbidity and mortality.